Special Advertising Section: Heart Health

From D Magazine February 2009

Half of all Americans will die of heart disease or stroke, those who suffer from heart disease will experience its negative effects not only in their health but also financially, as it’s one of the most costly diseases and a major cause of disability in the U.S. New projections show that all forms of cardiovascular disease will eventually cost our country more than $400 billion, including health care services, medications, and lost productivity.

You can avoid becoming a part of these grim statistics by taking a proactive approach in protecting your health by knowing your risk factors for heart disease and by taking advantage of the latest medical advances and technologies in early detection and intervention.

Understanding more about heart disease is a critical first step in identifying your risk factors. Heart disease is actually a blanket term that includes several more specific heart conditions. The most common heart disease in the U.S. is coronary artery disease, which can lead to heart attack. Other heart conditions include angina, heart failure, and arrhythmias.

The risk of coronary heart disease and other heart conditions can be reduced by taking steps to prevent and control those adverse factors that put people at greater risk for heart disease and heart attack. This isn’t a disease reserved for the older population. The nation’s authority on healthy hearts, the American Heart Association, recommends that heart attack prevention begin by age 20. This means assessing your risk factors and working to keep them low. For Americans age 40 and older or those with multiple risk factors, it’s important to calculate the risk of developing cardiovascular disease in the next 10 years. Because first-ever heart attacks or strokes can be fatal or disabling, prevention is critical.

Some risk factors for heart disease can be modified, treated, or controlled, and others can’t. The more risk factors you have, the greater your chance of developing coronary heart disease. Major risk factors that can’t be changed include increasing age (82 percent of people who die of coronary heart disease are 65 or older), gender (males tend to have a greater risk of heart disease, although more women die from it), and heredity. Risk factors that can be modified include smoking tobacco, high blood cholesterol, high blood pressure, physical inactivity, obesity and being overweight, and diabetes mellitus. Then there are contributing factors to heart disease that don’t necessarily cause the disease but can negatively affect it such as stress, alcohol consumption, and poor diet and nutrition.

“We talk to patients every day with or without heart disease about what they can do to prevent the disease or prevent further progression of the disease,” says Dr. David Brown, a cardiologist with The Dallas Heart Group. “We discuss everything from nutrition to having an active lifestyle and quitting smoking. If more people would heed our advice, they wouldn’t have to experience the effects of poor health choices.”

Heart disease can be identified earlier than ever before thanks to the latest non-invasive procedures, some available only in the Dallas area. With early intervention measures and preventive lifestyle changes, cardiac patients can pause or even reverse the effects of heart disease and hopefully avoid invasive heart surgery altogether. In fact, recent studies show that because of the latest detection technologies, bypass surgery rates are on the decline for the first time in years. Interventional cardiologist Dr. Tony Das of Cardiology and Interventional Vascular Associates (CIVA) promotes a comprehensive approach to treatment, in addition to preventive medicine and education. He does this for one primary reason: the heart is the one organ in the human body that every other vein, artery, and muscle depend on.

“Cardiac diagnosis and treatment should always incorporate a global vascular patient approach,” Dr. Das says. “The various forms cardiovascular disease assumes are the continuum of the risk factors leading to symptoms that can be found throughout the body before they actually reach the heart muscle.” »

Identifying Heart Disease

Open heart surgery rates are on the decline thanks to non-invasive options for catheters and stents that make recovery time and a return to normal activities shorter than ever before. Some advanced technologies benefiting patients throughout North Texas include drug-coated stents that can lower the incidence of scar tissue build-up in arteries following angioplasty; resynchronization therapy pacemakers and defibrillators for end-stage congestive heart failure patients; use of lasers in surgery to remove blockages in arteries; and the Diamondback Arthrectory Catheters that cut through the thick calcium deposits in the arteries.

“Education about cardiovascular disease has given the importance of identifying risk factors and paying attention to symptoms a significant push,” Dr. Das says. “We’re noticing that more people are seeking medical detection and intervention earlier in their doctors’ offices, rather than waiting to be diagnosed and treated all at once with emergency surgery.”

Your cardiologist may request one or more of the following tests to determine not only if you have heart disease, but also its stage.

Nuclear Stress Test. A nuclear stress test determines blood flow and blockage of arteries supplying the heart muscle. It is done by injecting medically safe levels of a tracer substance that is evaluated by pictures of the heart taken before and after stress testing. A nuclear scan is done to accurately determine blood flow and heart muscle function in a person suspected of coronary artery blockage.

Echocardiogram. To evaluate your heart size, structure, and function, or to investigate a heart murmur, your physician might order a resting echocardiogram with cardiac Doppler. This involves lying on your left side on a table while the sonographer moves a high-frequency probe on your chest to evaluate your heart. Some doctors do this in conjunction with a treadmill stress test, a stress echocardiogram, or a pharmacological stress echocardiogram. These different forms of stress testing are used to evaluate blood pressure and heart rate response, and to indirectly check for blockages in the arteries of the heart.

Heart and Vascular 64-Slice CT Scanner. The 64-Slice CT Scanner is the latest, diagnostic tool that is helping doctors to better diagnose cardiovascular disease This 3-D imaging scanner allows doctors to view any internal organs including the heart, lungs, kidney, and also arteries in the legs (peripheral) and diagnose any problems with these organs and associates arteries. CT Angiography tests can be valuable because they are noninvasive and allow for direct visualization of the arteries. Physicians can determine, for example, the severity of obstructive coronary disease, and can detect calcified and “soft” non-calcified plaques in the wall of the coronary artery before the disease results in significant obstruction. CT Angiography can rule out the need for more invasive diagnostic tools in about 30 to 50 percent of patients — those with indications for conventional angiography, but considered to be at low to medium risk. A CT may be used to evaluate patients who have acute or chronic chest pain, for example, or those with suspected coronary artery disease, following an abnormal stress test, thoracic and abdominal aortic disease, peripheral vascular disease as well as non-cardiac or non-vascular problems.

The 64-Slice CT scanner uses digital, computed tomography to produce the 3-D images. It is a machine with a hole in the center around which the imaging technology is housed (much like an MRI machine). The patient lies down on his/her back while the scanner slides back and forth. To create a clearer internal view, a contrast medium or dye is injected through an IV in the arm. ECG electrodes are positioned on the patient’s chest to synchronize the scanner to his/her heart rate. The patient will be asked to take a breath hold for a few seconds during each scan to allow optimal image quality. Each time the scanner completes one 360-degree rotation, one thin section or slice of the image is taken and your body is advanced slightly to take another image. These individual sections or slices are reassembled via computer to create a three dimensional image. The test takes anywhere from 15 to 30 minutes and is painless. “This technology is a great separator for those on the fence,” Dr. Brown says. “Maybe they have risk factors but haven’t presented. This test tells a lot about the severity of the disease.”

Intervention Procedures

“Research shows that the quicker a heart attack is treated the less potential damage there is to the heart muscle,” says Dr. Kenneth Saland, an interventional cardiologist with Texas Health Presbyterian Hospital Dallas. “Preserving more heart muscle helps the patient survive the heart attack and improves the long-term survival and quality of life for patients.”

Some of the latest interventional cardiology measures taking place in Dallas area hospitals include:Angioplasty. Angioplasty is used to prevent the occurrence of angina or a heart attack. The term angioplasty means remodeling of an artery. Coronary angioplasty refers to the use of one or more techniques to open a diseased coronary artery. Various angioplasty techniques have been developed to enlarge narrowed arteries without having to perform surgery. The goal is to reestablish good blood flow to all areas of the heart muscle.

Door-to-Door Balloon Angioplasty. The time it takes to treat a heart attack patient when he or she arrives in a hospital’s ER to the moment a balloon is deployed to open their blocked artery is called the “door-to-balloon” time. Major clinical studies, endorsed by the American Heart Association, have shown that treating heart attack patients within 90 minutes of arrival significantly reduces damage to the heart muscle. A patient recently treated at Texas Health Presbyterian Hospital Dallas underwent angioplasty to open the blocked artery in 28 minutes, a record achievement regionally and nationally.

Cardiac Catheterization. A heart attack can occur when blood flow to the heart is restricted due to plaque. If blockages occur in your arteries, your doctor will order a cardiac catheterization. This is a specialized diagnostic procedure designed to determine specific functions of your heart. It involves a small catheter being inserted into a groin (leg) artery and advanced up to the heart. Dye is then injected into the coronary arteries to visualize the blood flow. If any blockages are found, the doctor may choose to perform a balloon angioplasty to open the vessel. A stent may be used at this time to maintain an open artery. When the catheter is removed, the artery is more widely open and good blood flow to the heart is restored.

Heart Health: Where to Turn for Help

Baylor Jack and Jane Hamilton Heart and Vascular Hospital

Baylor Jack and Jane Hamilton Heart and Vascular Hospital provides inpatient and outpatient services focused on preventive health care and comprehensive cardiovascular disease management. Designed as a patient-centered facility, features include cardiac catheterization and electrophysiology laboratories, surgical suites, an imaging department with 64-slice CT scanner, cardiac rehabilitation areas, physician offices, and a research facility. Baylor Hamilton Heart and Vascular Hospital’s specialized clinical team and medical staff perform an array of procedures including angioplasty, cardiac rehabilitation, heart valve surgery, and implantation of defibrillators and pacemakers. Clinical research is underway to study advanced technology, such as new pacemakers, defibrillators, drug-coated stents and medications to treat high blood pressure and cholesterol, all of which continue to revolutionize the treatment of heart disease. The Baylor Heart and Vascular Institute’s Community Resource Center provides educational resources to all who are interested in learning more about heart and vascular health. “Being heart healthy is not always an obvious thing,” says Dr. Rafic Berbarie, a cardiologist on the medical staff at Baylor. “This is why we push education about heart health, to give our patients easier access to critical, life-saving information.”Baylor now offers a cardiac calcium scoring program, a non-invasive test to check for the buildup of cholesterol on the walls of arteries of the heart. This test is used for early detection of heart disease – even before symptoms appear. Calcium score screening heart scans, affordably priced at just $79, are available Monday through Friday at Baylor. Screening only takes a few minutes to perform and does not require a physician order. Insurance does not cover screenings. Baylor also offers Leap For Life®. Designed to meet the needs of patients with heart disease, Leap for Life® teaches what you can do now to manage your disease and possibly improve your health. It’s a wellness and disease prevention program that utilizes behavior change techniques to help heart patients achieve better health. In this one-day educational workshop, you will learn the latest about simple changes you can make to improve your heart health.Physicians are members of the medical staff at one of Baylor Health Care Systems’ subsidiary, community or affiliated medical centers and are neither employees nor agents of those medical centers, Baylor Heart and Vascular Holpital, or Baylor Health Care SystemsTexas Health Presbyterian Hospital DallasBecause heart disease continues to be a major health problem throughout the United States, Texas Health Presbyterian Hospital Dallas and physicians on the medical staff are committed to providing quality cardiovascular care to patients. This commitment is manifested in the variety of available cardiovascular services, from diagnosis, treatment, and rehabilitation to education and prevention. It is also shown in the strength of the medical staff, the quality of the facilities dedicated to cardiovascular care, and the volume of cases handled at the hospital each year. There are more than 30 cardiologists and cardiothoracic surgeons on the medical staff at Texas Health Presbyterian. These respected physicians lead multidisciplinary teams that include nurses, technicians, physiologists, scientists and researchers, rehabilitation specialists, and other trained and skilled personnel. Physicians on the medical staff at Texas Health Presbyterian are committed to assessing the effectiveness of newly developed technologies in the fight against heart disease. Because of its active participation in ongoing medical research, Texas Health Presbyterian has been selected as the site for numerous clinical trials that serve to evaluate the efficacy of various cardiac therapies, says Dr. James Park, medical director of the cardiac catheterization lab at Texas Health Presbyterian. Major clinical breakthroughs in the diagnosis and treatment of cardiovascular-related diseases provide patients with the possibility of more positive outcomes. The facilities in which these professionals work are no less impressive. The hospital has operating suites dedicated to cardiovascular surgery, plus multiple telemetry beds for specialized monitoring of cardiac patients. There is also a separate section of the Emergency Department at Texas Health Presbyterian devoted to triaging and treating patients suffering from chest pain and other symptoms of heart attack.Texas Health Presbyterian is leading the way in the following areas:Minimally Invasive Techniques. While there will always be a need for traditional surgeries, advancements in vascular surgery have made it possible for surgeons to operate through tiny puncture holes rather than large incisions. As a result, surgeons can achieve the same results from the procedure with fewer traumas to the patient’s body. Some of these techniques include endografting for thoracic and abdominal aortic aneurysms, angioplasty for peripheral vascular disease, carotid artery stenting, and varicose vein treatment.“Within the past decade, minimally invasive procedures have really grown in popularity,” says Russell Lam, M.D., medical director of endovascular surgery at Texas Health Presbyterian and a vascular and endovascular surgeon on the hospital medical staff. “Today, about 75 percent of the procedures performed are done through minimally invasive techniques.” Peripheral vascular disease. PVD is a common condition affecting more than 10 million adults in the United States. The condition is a disease of blood vessels outside the heart and brain characterized by a narrowing of vessels that carry blood to the legs, arms, stomach, and kidneys. With the prevalence of diabetes and obesity among an already aging population, the challenges facing those involved in the diagnosis and treatment of peripheral vascular disease are overwhelming. Cardiovascular surgeons Texas Health Presbyterian Hospital Dallas perform complex vascular procedures to open and stent arteries supplying the kidneys and other organs. They also use advanced techniques to open complex blockages of the femoral and tibial arteries, which supply blood to the lower limbs. Texas Health Presbyterian physicians are using a new technique to treat these blockages that involves using a tiny crown coated with diamond chips that rapidly spins at high speeds and sands away plaque inside leg arteries — while preserving the healthy tissue of the arterial wall. Orbital rotational force causes the tip of the device to expand inside the artery as it slowly sands away plaque and opens the artery to restore proper blood flow. Southwest Diagnostic Imaging CenterSouthwest Diagnostic Imaging Center (SWDIC) proudly offers a full range of cardiac screening and diagnostic imaging tests, including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). SWDIC has two GE Lightspeed CT scanners and has four MRI scanners including the GE Signa EXCITE HDx 3.0T, which is three times stronger than the standard MRI. SWDIC also has the technology to create three dimensional (3-D) reconstruction images of the heart. These 3-D reconstructions assist the Radiologists in interpreting Cardiac CT and MRI exams. One of the leading causes of death in the United States is heart disease. The most common type of heart disease is Coronary Artery Disease (CAD), a condition in which plaque builds up inside the coronary arteries. An imaging procedure, called a CT Cardiac Calcium Scoring exam assesses risk factors and images calcium deposits or plaque in the arteries. A score is then shared with the patient’s physician to help detect the early stages of heart disease and manage treatment. A similar type of CT exam, called Cardiac Computed Tomography Angiography (CCTA), can be used to look at the structures of the heart and blood vessels. In addition to estimating the amount of blockage or calcium in the arteries, the anatomy and structure of the heart is imaged to detect any abnormalities. These images are reformatted into 3-D reconstructions to provide more conclusive results by our Radiologists.During a Cardiac MRI, images of the heart beating are captured demonstrating different aspects of the cardiac cycle. This creates both still and moving images of the heart muscle and blood flow which can be used to diagnose and evaluate many conditions including: damage to the heart muscle following a heart attack; heart failure; heart valve problems; congenital heart disease; CAD; and cardiac tumors. The rate and direction of blood flow can be calculated as well using 3-D reconstructed images.SWDIC a state-of-the-art facility is located on the Presbyterian Hospital campus in Dallas. As one of Dallas’s most reputable independent imaging centers with over 25 years of service, SWDIC employs more than 240 highly educated and skilled healthcare professionals and is affiliated with two associations of physicians: Southwest Imaging and Interventional Specialists and Texas Neuroradiology, PA. SWDIC’s mission is to provide unsurpassed patient care, the most advanced diagnostic imaging technology, and the highest standards of quality. The Center will assist physicians and health care providers in every way possible to ensure the finest in patient care. Imaging studies are detailed and extensive, ensuring quality. Cardiology and Interventional Vascular Associates The board-certified physicians at CIVA, supported by a team of experienced nurse practitioners, have a reputation for excellence in diagnosing and pioneering innovative treatments for cardiovascular disease. Notable facts about CIVA include:Eight board-certified physicians whose combined talents cover the spectrum of cardiovascular conditions and treatment and six nurse practitioners and physician assistants, all highly experienced in cardiovascular core. Leading research in the fields of congestive heart failure, new devices for coronary artery and peripheral vascular disease, heart rhythm problems and hypertension. State-of-the-art diagnostic and testing equipment for early diagnosis of cardiac and vascular problems with stress testing, 64-slice CT whole body scanner, echocardiography, nuclear medicine imaging and peripheral vascular Doppler imaging. Expert non-surgical treatment of coronary blockages with drug-coated stents, stroke prevention with carotid artery stents, lasers and Diamondback atherectomy for lower extremity vascular disease, non-surgical patches for holes in the heart (PFO/ASD), stent grafts for aortic aneurysms, and more. Proficient catheter ablation of difficult cardiac arrhythmias and pacemaker and defibrillator implantation. Endovenous laser treatment for varicose veins and venous stasis ulcers. The Cardiovascular Research Institute of Dallas has access to CIVA for support services, including echocardiography, nuclear stress testing, CT angiography, Holter monitoring, and laboratory studies. Ongoing research studies include congestive heart failure, atrial fibrillation, hypertension, acute coronary syndrome, and peripheral artery disease.The Cardiovascular Research Institute of Dallas has been involved in numerous clinical pharmaceutical and interventional research protocols. Major areas of research include heart failure, atrial fibrillation, hypertension, anticoagulation, hyperlipidemia, and cardiac and vascular interventional procedures. The Dallas Heart GroupFor the past 20 years, The Dallas Heart Group has had a strong commitment to offering the highest level of cardiac care and personal service. Skilled physicians stay on the forefront of medical breakthroughs, working hard to offer patients the most effective and appropriate treatments available to live longer, healthier lives. Dallas Heart Group believes in partnering with patients and their referring physicians to ensure open communication and well-informed medical decisions. Dallas Heart Group strives to improve the quality of life for patients by providing the most recent diagnostic advances in technology, allowing for a less-invasive experience in the detection of cardiovascular problems. Dallas Heart Group offers procedures that can be done right in the comfort of the office, such as testing for carotid stenosis, abdominal aortic aneurysm, and peripheral arterial diseases. Many tests can be completed on its state-of-the art 64-slice CT imaging and other advanced diagnostic equipment. The goal is to develop a strategy of diagnosis and treatment that is right for each individual with the best possible outcome. The physicians and staff at The Dallas Heart Group are dedicated to helping patients take charge of their health through prevention, the most advanced testing available, and lifesaving, minimally invasive interventions.